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Objective. A systematic review and meta-analysis was performed to assess potential differences in perioperative outcomes and disease-free survival (DFS) and overall survival (OS) of patients with pathological stage IA non-small cell lung cancer (NSCLC) who underwent minimally invasive anatomical segmentectomy or lobectomy. Methods. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of EMBASE (through Ovid), MEDLINE (via PubMed), and Cochrane CENTRAL was conducted. Two researchers independently reviewed each eligible study that included patients with stage IA NSCLC who underwent minimally invasive anatomical segmentectomy and lobectomy and compared perioperative and/or survival outcomes of patients. Results. A total of 887 publications were identified. Of these, 10 articles met our eligibility criteria. A significantly higher number of lymph nodes were harvested in lobectomies. The two groups did not significantly differ in postoperative complication rates, DFS, and OS. Patients who underwent segmentectomy had shorter postoperative hospital stays. Conclusions. Minimally invasive lobectomy and segmentectomy showed comparable short-term and long-term outcomes in stage IA NSCLC patients. Postoperative complication rates were similar. Minimally invasive lobectomies are associated with a higher number of harvested lymph nodes, although this did not affect the final staging or the survival outcomes.

Background. Robotic-assisted bronchoscopy with the ION™ Endoluminal System facilitates precise access to peripheral pulmonary lesions. However, procedural duration and diagnostic performance remain influenced by patient and lesion-specific factors. To investigate the impact of lesion diameter, radiological appearance, and presence of bronchial signs on procedural duration and diagnostic yield using conventional regression and gradient boosting machine learning models. Methods. In this single-center retrospective cohort study, 189 ION™ Endoluminal System procedures (November 2024–June 2025) were analyzed. Procedural duration and diagnostic yield served as primary outcomes. Predictive modeling included multivariable regression and gradient boosting. Feature importance metrics were extracted. Results. The median lesion diameter was 12.3 mm, with a “strict” diagnostic yield of 87.3%. Gradient boosting regression identified lesion diameter as the primary predictor of procedural time (89.2% importance; test MSE = 865.6). Diagnostic classification achieved an ROC-AUC of 0.68, with lesion diameter (85.8%) and bronchial sign (14.2%) as key predictors. Conclusions. Lesion diameter emerged as the most consistent predictor of procedural efficiency and was associated with diagnostic performance, albeit within the limitations of the dataset. Broader datasets are needed for external validation and generalizability.

Backgrounds/Objectives: Malignant pleural effusion (MPE) is a frequent complication of advanced cancer, and talc pleurodesis via video-assisted thoracoscopic surgery (VATS) represents a standard palliative treatment with high efficacy. However, evidence regarding synchronous bilateral pleurodesis in patients with bilateral MPE is limited. This study evaluates the feasibility, safety, and outcomes of a single-stage bilateral VATS talc pleurodesis approach. Materials and Methods: We retrospectively analyzed patients undergoing synchronous bilateral VATS talc poudrage between 2000 and 2025 at a single tertiary cancer center. Inclusion criteria included adult patients with bilateral MPE, expandable lungs, and suitability for surgery. Preoperative assessment involved imaging and multidisciplinary evaluation. Perioperative data, complications, mortality, and recurrence rates at 30 days and 3 months were collected. Survival and pleural effusion-free survival were estimated using the Kaplan–Meier method. Results: Thirty patients were included (median age 63.2 years). The most common primary tumors were breast (43%), lung (30%), and ovarian cancer (17%). Mean operative time was 78.6 min, with no intraoperative complications. Mean hospital stay was 6 days. Postoperative morbidity included atrial fibrillation (13%) and respiratory failure (6.6%), both managed conservatively. Thirty-day mortality was 3%. Pleural effusion recurrence occurred in 6.6% at 3 months and 10% at 7 months. Mean follow-up was 9.7 months. Conclusions: Synchronous bilateral VATS talc pleurodesis is a feasible and safe procedure in selected patients with bilateral MPE with acceptable morbidity. Further prospective studies are needed to confirm these findings and refine patient selection.

The molecular concordance between primary lung adenocarcinoma and metastatic lesions remains incompletely characterized despite its direct implications for precision oncology and biopsy-driven therapeutic decision-making. This prospective monocentric paired-sample study evaluated genomic concordance between primary lung adenocarcinoma and synchronous thoracic metastatic lesions using targeted next-generation sequencing (NGS). We identified 27 treatment-naïve patients with histologically confirmed lung adenocarcinoma who underwent paired molecular profiling of the primary tumor and a synchronous thoracic metastatic site (pleural or intrapulmonary). DNA and RNA were analyzed using validated institutional NGS platforms. Genomic alterations, including clinically actionable oncogenic drivers consistently covered by the sequencing panel used in each pair, were compared across matched samples. Concordance was assessed using exact binomial confidence intervals, Cohen's κ statistics, McNemar tests, and paired Wilcoxon signed-rank tests. Actionable driver alterations were identified in 17 of 27 patients (63.0%; 95% CI 42.4-80.6), including mutations (40.7%), alterations (18.5%), and one gene rearrangement (3.7%). concurrent mutations were detected in 14 cases (51.9%). Across all 27 paired samples, driver-level concordance was 100% (95% CI 87.2-100), with perfect agreement for , , and alterations (κ = 1.00). mutations showed high concordance (92.9%; κ = 0.85), while CNVs were concordant in 88.0% of evaluable pairs. Variant allele frequency (VAF) comparisons, adjusted for tumor cellularity, further supported the apparent clonal stability of driver alterations across paired samples. This study demonstrates very high molecular concordance between primary lung adenocarcinomas and their synchronous pleural or intrapulmonary metastases. The observed 100% concordance of actionable driver alterations across paired specimens supports the clinical reliability of thoracic metastatic biopsies for baseline molecular profiling in treatment-naïve disease. Although limited by sample size, these findings support the biological stability of actionable driver alterations during early thoracic metastatic dissemination.

Introduction Pulmonary segmentectomy, when combined with hilar and mediastinal lymphadenectomy, is currently considered the gold standard treatment for early-stage lung tumors (NSCLC) smaller than 2 cm in diameter. The preoperative planning for segmentectomies usually includes a contrast-enhanced CT with 2D reconstructions (axial, coronary, and sagittal). Recent technological advances allow 3D (volume rendering) reconstructions of preoperative CT scans, intended to improve the surgeon’s understanding of the segmental anatomy. The study aims to investigate the added value of 3D reconstruction in enhancing the surgeon’s understanding of anatomical structures, thus facilitating surgical planning and improving oncological outcomes. Methods and analysis This is a prospective, randomized, controlled study. Patients will be randomized into two groups: 1. Group 2D: the preoperative workup for these patients will consist of a contrast-enhanced chest CT with two-dimensional (2D) reconstructions (axial, coronary, and sagittal); 2. Group 3D: the preoperative workup for these patients will consist of a contrast-enhanced chest CT with two-dimensional (2D) reconstructions (axial, coronary, and sagittal) and a 3D reconstruction (volume rendering) of the same chest CT employing dedicated software. The primary endpoints will be negative margin (R0) resection rate, resection margin (staple line-to-tumor distance), and thoracotomy conversions. We will use Fisher’s exact test for binary outcomes and Mann–Whitney U test for continuous outcomes. For subgroup analyses, we will use regression. Multivariable analyses will be based on logistic regression for binary outcomes and linear regression for continuous outcomes. Ethics and dissemination The protocol and the model informed consent forms have been reviewed and approved by the ethics committee (N.: 1–2023) concerning scientific content and compliance with applicable research and human subject regulations. A Subcommittee on Publications was established to review all publications and report its recommendations to the steering committee. The anonymized participant-level dataset and statistical code for generating the results will not be publicly available. Trial registration The protocol was registered at ClinicalTrials.gov (ID: NCT05716815; Prospective rAndomized sTudy efficaCy tHree-dimensional rEconstructions Segmentectomy - Full-Text View - ClinicalTrials.gov). Jan 19, 2023.

Background. To comprehensively assess surgical safety, we conducted a meta-analysis on neoadjuvant chemo-immunotherapy for NSCLC. Methods. This systematic review and meta-analysis followed PRISMA guidelines (PROSPERO: CRD42023470682). A literature search and data extraction were performed independently by two reviewers. Primary outcomes included surgical feasibility and safety. Pooled prevalence proportions with 95% confidence intervals (CIs) were calculated. A random-effects model was applied if heterogeneity was significant (I2 ≥ 50% or p ≥ 0.10). Sensitivity analysis assessed robustness and publication bias was examined using funnel plots and Egger’s test (p < 0.05 significant). Results. Fifteen studies were included, analyzing different immune checkpoint inhibitors with 2–3 cycles of neoadjuvant therapy. Surgery occurred 10–45 days post-treatment. The pooled surgical resection rate was 98.96% (95% CI: 98.93–98.98, I2 = 0%). The conversion to thoracotomy rate was 16.49% (95% CI: 12.95–20.03, I2 = 89.74%). Minimally invasive surgery was performed in 53.62% (95% CI: 49.53–57.72, I2 = 95.92%). The median surgical delay was 28.53 days (95% CI: 23.66–33.41, I2 = 0%). Surgical time averaged 165.27 min (95% CI: 112.32–218.22, I2 = 0%), with mean blood loss of 182.0 mL (95% CI: 134.0–230.0, I2 = 0%). Conclusions. Surgical intervention following neoadjuvant chemo-immunotherapy for NSCLC is feasible and safe, with a high resection rate (98.96%). Variability in minimally invasive surgery and conversion rates suggests differences in surgical approaches, while surgical time, blood loss, and delay showed consistency. These findings highlight the need for a multidisciplinary approach to optimize patient outcomes.

Objectives: Adenocarcinoma presenting as ground-glass opacities (GGOs) often corresponds to lepidic growth tumor and is associated with less invasive behavior and a good prognosis. The aim of this study is to investigate the correlation between radiological and pathological findings of GGO and their relationship with lung cancer-specific survival (LCSS) and incidence of relapses to better define their surgical management. Methods: One hundred seventy-two patients underwent lung resection for adenocarcinoma presenting as pure GGO or partial solid GGO at CT scan. Based on consolidation-to-tumor ratio (CTR) at CT scan, patients were categorized into two groups: pure GGO (CTR 0) and partial solid GGO (CTR ≤ 0.5, 0.5 < CTR ≤ 0.75, and 0.75 < CTR ≤ 1.0). Histological analysis confirmed diagnosis, invasiveness, and grading. Results: Comparing the group with pure GGO (n = 90; 52.3%) and the groups with partial solid GGO (n = 82; 47.7%), invasive adenocarcinoma was significantly more frequent in the last one (p = 0.0006). In the partial solid GGO group, the majority of tumors were G2, and the percentage of G3 tumors increased with the CTR increasing (p < 0.0001). Twenty-one (12.2%) patients experienced disease recurrence: 16 (9.3%) were invasive adenocarcinoma (IA), and 5 (2.9%) were minimally invasive adenocarcinomas (MIA); radiologically, 13 (7.5%) were pure GGO, and 8 (4.6%) had a solid component. At multivariate analysis, relapse was associated with age > 60 (p = 0.037), clinical stage ≥ cIB (p = 0.002), and sublobar resection (p = 0.005). Conclusions: Pure GGO was associated with minor invasiveness, with prognosis dependent on age, clinical stage, and type of surgery (sublobar vs. lobar resection). Sublobar resections had a higher recurrence risk.